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BUILDI
GDEPARTIVIENT
VIL A OF RYE BROOK JUN - 3 2022
938 KIN EET RYE BIt90 NY 10573
9-060 VILLAGE OF RYE BROOK
r66k�brg BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
J
Approval Date:
,�UN 1 6 2022 ermit# � !o 7 Application#
Approval Signature: 'V ARCHITECTURAL REVIEW
BOARD:
9
Disapproved: Date:
BOT Approval Date: Case# ; Chairman: -
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee '!`"� Permit Fees: 1 �'
FENCE / WALL / GATE PERMIT APPLICATION
Application dated: 1 1 1207a is hereby made to the Building Inspectorofthe Village of Rye Brook,NY,for the issuance of Permit
for the installation,construction,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of
Rye Brook.as per detailed statement described below. Swimming pool fences must conform to the State Code.
1. Job Address: 1' Car R4r. RnwK1
2. Occupancy/LJse:s' 'S
S.B.L.#: 13509200nt00Clc7,n000,0 Zone:
3. Proposed Fence/Wall/Gate(describe in detail):
Ce ted at�,���i`orou�
4. Property Owner: Ran r�
Address: r
Phone# Cell#^j lA doh 498 email: Kris
Applicant: -
Address: It
Phone# Cell# email: u Architect/Engineer:IQ
Address:
Cell #
Phone# email:� q I y $�
M
Contractor: p� , �/
Address&Phone: 7 Wed fa(� ACe -Ad-L1`!� N I 10513
5. If building is located on a corner lot,which street does it front on: At 1
hie Ant (W
6. What is the estimated cost of construction 6 b 000 Jr% st 7=0'
(NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and
material and labor which may be donated gratis.)
7. Estimated date of completion: L4Ahld y IZe GCS
811212021
Please note that this application must include the notarized signature(s) of the legal owner(s)
of the above-mentioned property, in the space provided below. Any application not bearing
the legal property owner's notarized signature(s) shall be deemed null and void, and will be
returned to the applicant.
STAOF NEW YOR&COUNTY OF WESTCHESTER ) as:
being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the
for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,agent,attomey,etc.)
That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use
conducted at the above captioned property will be in conformance with the details as set forth and contained in this application
and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire
Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Sworn to before me this 30 Sworn to before me this
day of ✓yM` , 20 2_IZI day of , 20
Signature of Property Owner Signature of Applicant
qAW N . '�'2okAN-
Print Name of Pr perty Owner Print Name of Applicant
otary Pub '- Notary Public
DREW ALEXANDER
Notary Public of New York
t.D.CIAL6416M
COMMISSIUN EXPM B Q3IM/M
811212021